What are the current first-line treatment options for managing JIA in primary care?

First-line treatment options for managing juvenile idiopathic arthritis (JIA) in primary care primarily involve early referral to specialist paediatric rheumatology services for diagnosis and initiation of treatment, as JIA management is complex and usually requires specialist oversight.

However, in primary care, initial management may include symptom relief with nonsteroidal anti-inflammatory drugs (NSAIDs) at the lowest effective dose for the shortest duration to control pain and inflammation while awaiting specialist assessment.

Glucocorticoids (oral, intramuscular, or intra-articular) may be used as short-term bridging therapy to rapidly reduce inflammation, but their use should be coordinated with specialist advice.

Conventional disease-modifying anti-rheumatic drugs (cDMARDs) such as methotrexate, sulfasalazine, or leflunomide are the mainstay of treatment but are typically initiated and monitored by specialists; primary care may be involved in ongoing prescribing and monitoring under shared care agreements.

Hydroxychloroquine may be considered for milder or palindromic forms of arthritis.

Overall, primary care's role includes symptom management, ensuring timely referral, supporting medication adherence, monitoring for adverse effects, and coordinating care with specialists.

Specific UK guidelines for adult rheumatoid arthritis and spondyloarthritis recommend these approaches, and while direct JIA guidelines are not detailed in the provided context, the principles of early specialist involvement and use of NSAIDs, glucocorticoids, and cDMARDs apply similarly in paediatric practice.

Therefore, the first-line treatment in primary care is mainly supportive and preparatory for specialist-led disease-modifying therapy.

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